Mental Wellness Survey Name * First Name Last Name Email * Form * Please rate the following statements on a scale of how strongly you are or disagree with the statement based on the PAST 30 DAYS. I am open to new ways of looking at things Strongly Disagree Disagree Neutral Agree Strongly Agree I can calm myself down when I get upset Strongly Disagree Disagree Neutral Agree Strongly Agree I can hold my attention Strongly Disagree Disagree Neutral Agree Strongly Agree My life has meaning or purpose Strongly Disagree Disagree Neutral Agree Strongly Agree I have a plenty of energy Strongly Disagree Disagree Neutral Agree Strongly Agree I have a positive attitude toward life Strongly Disagree Disagree Neutral Agree Strongly Agree I practice gratitude daily Strongly Disagree Disagree Neutral Agree Strongly Agree I notice where my attention goes Strongly Disagree Disagree Neutral Agree Strongly Agree It is easy for me to start a conversation with a stranger Strongly Disagree Disagree Neutral Agree Strongly Agree I wake up feeling refreshed every day Strongly Disagree Disagree Neutral Agree Strongly Agree I am able to let go of unwanted thoughts Strongly Disagree Disagree Neutral Agree Strongly Agree My internal self talk is positive Strongly Disagree Disagree Neutral Agree Strongly Agree I notice positive things more than negative things Strongly Disagree Disagree Neutral Agree Strongly Agree It is easy for me to talk about my emotions Strongly Disagree Disagree Neutral Agree Strongly Agree I focus on getting exercise weekly Strongly Disagree Disagree Neutral Agree Strongly Agree I practice being fully present in the moment Strongly Disagree Disagree Neutral Agree Strongly Agree I treat myself like I would a good friend Strongly Disagree Disagree Neutral Agree Strongly Agree I can distance myself from toxic distractions Strongly Disagree Disagree Neutral Agree Strongly Agree I feel upset when others around me are upset Strongly Disagree Disagree Neutral Agree Strongly Agree I have a healthy and nutritious diet Strongly Disagree Disagree Neutral Agree Strongly Agree I believe my thoughts are always correct Strongly Disagree Disagree Neutral Agree Strongly Agree I do helpful things for others daily Strongly Disagree Disagree Neutral Agree Strongly Agree I notice when my mind wanders to the past or the future Strongly Disagree Disagree Neutral Agree Strongly Agree I am able to feel love for myself Strongly Disagree Disagree Neutral Agree Strongly Agree I take care of my body and my mind Strongly Disagree Disagree Neutral Agree Strongly Agree Thank you!
